|
HC HEEL NEW LEATHER
|
Facility
|
OP
|
$80.00
|
|
|
Service Code
|
CPT L3455
|
| Hospital Charge Code |
915353455
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$15.91 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Adventist Health Commercial |
$32.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$68.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$44.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.98
|
| Rate for Payer: Blue Shield of California Commercial |
$61.84
|
| Rate for Payer: Blue Shield of California EPN |
$40.32
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Central Health Plan Commercial |
$64.00
|
| Rate for Payer: Cigna of CA HMO |
$56.00
|
| Rate for Payer: Cigna of CA PPO |
$56.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$68.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$68.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.00
|
| Rate for Payer: EPIC Health Plan Senior |
$32.00
|
| Rate for Payer: Galaxy Health WC |
$68.00
|
| Rate for Payer: Global Benefits Group Commercial |
$48.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$72.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$15.91
|
| Rate for Payer: InnovAge PACE Commercial |
$40.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$56.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$56.00
|
| Rate for Payer: Multiplan Commercial |
$60.00
|
| Rate for Payer: Networks By Design Commercial |
$40.00
|
| Rate for Payer: Prime Health Services Commercial |
$68.00
|
| Rate for Payer: Riverside University Health System MISP |
$32.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$48.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$48.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.02
|
| Rate for Payer: United Healthcare All Other HMO |
$29.22
|
| Rate for Payer: United Healthcare HMO Rider |
$28.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$68.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.00
|
| Rate for Payer: Vantage Medical Group Senior |
$68.00
|
|
|
HC HEEL NEW LEATHER
|
Facility
|
IP
|
$80.00
|
|
|
Service Code
|
CPT L3455
|
| Hospital Charge Code |
915353455
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Adventist Health Commercial |
$16.00
|
| Rate for Payer: Blue Shield of California Commercial |
$61.84
|
| Rate for Payer: Blue Shield of California EPN |
$40.32
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Central Health Plan Commercial |
$64.00
|
| Rate for Payer: Cigna of CA HMO |
$56.00
|
| Rate for Payer: Cigna of CA PPO |
$56.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.00
|
| Rate for Payer: EPIC Health Plan Senior |
$32.00
|
| Rate for Payer: Galaxy Health WC |
$68.00
|
| Rate for Payer: Global Benefits Group Commercial |
$48.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$72.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.00
|
| Rate for Payer: Multiplan Commercial |
$60.00
|
| Rate for Payer: Networks By Design Commercial |
$52.00
|
| Rate for Payer: Prime Health Services Commercial |
$68.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.02
|
| Rate for Payer: United Healthcare All Other HMO |
$29.22
|
| Rate for Payer: United Healthcare HMO Rider |
$28.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.20
|
|
|
HC HEEL NEW LEATHER
|
Facility
|
IP
|
$80.00
|
|
|
Service Code
|
CPT L3455
|
| Hospital Charge Code |
905353455
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Adventist Health Commercial |
$16.00
|
| Rate for Payer: Blue Shield of California Commercial |
$61.84
|
| Rate for Payer: Blue Shield of California EPN |
$40.32
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Central Health Plan Commercial |
$64.00
|
| Rate for Payer: Cigna of CA HMO |
$56.00
|
| Rate for Payer: Cigna of CA PPO |
$56.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.00
|
| Rate for Payer: EPIC Health Plan Senior |
$32.00
|
| Rate for Payer: Galaxy Health WC |
$68.00
|
| Rate for Payer: Global Benefits Group Commercial |
$48.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$72.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.00
|
| Rate for Payer: Multiplan Commercial |
$60.00
|
| Rate for Payer: Networks By Design Commercial |
$52.00
|
| Rate for Payer: Prime Health Services Commercial |
$68.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.02
|
| Rate for Payer: United Healthcare All Other HMO |
$29.22
|
| Rate for Payer: United Healthcare HMO Rider |
$28.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.20
|
|
|
HC HEEL NEW LEATHER
|
Facility
|
OP
|
$80.00
|
|
|
Service Code
|
CPT L3455
|
| Hospital Charge Code |
905353455
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$15.91 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Adventist Health Commercial |
$32.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$68.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$44.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.98
|
| Rate for Payer: Blue Shield of California Commercial |
$61.84
|
| Rate for Payer: Blue Shield of California EPN |
$40.32
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Central Health Plan Commercial |
$64.00
|
| Rate for Payer: Cigna of CA HMO |
$56.00
|
| Rate for Payer: Cigna of CA PPO |
$56.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$68.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$68.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.00
|
| Rate for Payer: EPIC Health Plan Senior |
$32.00
|
| Rate for Payer: Galaxy Health WC |
$68.00
|
| Rate for Payer: Global Benefits Group Commercial |
$48.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$72.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$15.91
|
| Rate for Payer: InnovAge PACE Commercial |
$40.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$56.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$56.00
|
| Rate for Payer: Multiplan Commercial |
$60.00
|
| Rate for Payer: Networks By Design Commercial |
$40.00
|
| Rate for Payer: Prime Health Services Commercial |
$68.00
|
| Rate for Payer: Riverside University Health System MISP |
$32.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$48.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$48.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.02
|
| Rate for Payer: United Healthcare All Other HMO |
$29.22
|
| Rate for Payer: United Healthcare HMO Rider |
$28.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$68.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.00
|
| Rate for Payer: Vantage Medical Group Senior |
$68.00
|
|
|
HC HEEL NEW RUBBER
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
CPT L3460
|
| Hospital Charge Code |
905353460
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Adventist Health Commercial |
$14.00
|
| Rate for Payer: Blue Shield of California Commercial |
$54.11
|
| Rate for Payer: Blue Shield of California EPN |
$35.28
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: Central Health Plan Commercial |
$56.00
|
| Rate for Payer: Cigna of CA HMO |
$49.00
|
| Rate for Payer: Cigna of CA PPO |
$49.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.00
|
| Rate for Payer: EPIC Health Plan Senior |
$28.00
|
| Rate for Payer: Galaxy Health WC |
$59.50
|
| Rate for Payer: Global Benefits Group Commercial |
$42.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.00
|
| Rate for Payer: Multiplan Commercial |
$52.50
|
| Rate for Payer: Networks By Design Commercial |
$45.50
|
| Rate for Payer: Prime Health Services Commercial |
$59.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.27
|
| Rate for Payer: United Healthcare All Other HMO |
$25.57
|
| Rate for Payer: United Healthcare HMO Rider |
$25.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.93
|
|
|
HC HEEL NEW RUBBER
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
CPT L3460
|
| Hospital Charge Code |
905353460
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7.05 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Adventist Health Commercial |
$28.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$59.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$52.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.11
|
| Rate for Payer: Blue Shield of California Commercial |
$54.11
|
| Rate for Payer: Blue Shield of California EPN |
$35.28
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: Central Health Plan Commercial |
$56.00
|
| Rate for Payer: Cigna of CA HMO |
$49.00
|
| Rate for Payer: Cigna of CA PPO |
$49.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$59.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$59.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.00
|
| Rate for Payer: EPIC Health Plan Senior |
$28.00
|
| Rate for Payer: Galaxy Health WC |
$59.50
|
| Rate for Payer: Global Benefits Group Commercial |
$42.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.05
|
| Rate for Payer: InnovAge PACE Commercial |
$35.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$49.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.00
|
| Rate for Payer: Multiplan Commercial |
$52.50
|
| Rate for Payer: Networks By Design Commercial |
$35.00
|
| Rate for Payer: Prime Health Services Commercial |
$59.50
|
| Rate for Payer: Riverside University Health System MISP |
$28.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.27
|
| Rate for Payer: United Healthcare All Other HMO |
$25.57
|
| Rate for Payer: United Healthcare HMO Rider |
$25.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$59.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$59.50
|
| Rate for Payer: Vantage Medical Group Senior |
$59.50
|
|
|
HC HEEL NEW RUBBER
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
CPT L3460
|
| Hospital Charge Code |
915353460
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7.05 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Adventist Health Commercial |
$28.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$59.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$52.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.11
|
| Rate for Payer: Blue Shield of California Commercial |
$54.11
|
| Rate for Payer: Blue Shield of California EPN |
$35.28
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: Central Health Plan Commercial |
$56.00
|
| Rate for Payer: Cigna of CA HMO |
$49.00
|
| Rate for Payer: Cigna of CA PPO |
$49.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$59.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$59.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.00
|
| Rate for Payer: EPIC Health Plan Senior |
$28.00
|
| Rate for Payer: Galaxy Health WC |
$59.50
|
| Rate for Payer: Global Benefits Group Commercial |
$42.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.05
|
| Rate for Payer: InnovAge PACE Commercial |
$35.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$49.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.00
|
| Rate for Payer: Multiplan Commercial |
$52.50
|
| Rate for Payer: Networks By Design Commercial |
$35.00
|
| Rate for Payer: Prime Health Services Commercial |
$59.50
|
| Rate for Payer: Riverside University Health System MISP |
$28.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.27
|
| Rate for Payer: United Healthcare All Other HMO |
$25.57
|
| Rate for Payer: United Healthcare HMO Rider |
$25.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$59.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$59.50
|
| Rate for Payer: Vantage Medical Group Senior |
$59.50
|
|
|
HC HEEL NEW RUBBER
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
CPT L3460
|
| Hospital Charge Code |
915353460
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Adventist Health Commercial |
$14.00
|
| Rate for Payer: Blue Shield of California Commercial |
$54.11
|
| Rate for Payer: Blue Shield of California EPN |
$35.28
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: Central Health Plan Commercial |
$56.00
|
| Rate for Payer: Cigna of CA HMO |
$49.00
|
| Rate for Payer: Cigna of CA PPO |
$49.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.00
|
| Rate for Payer: EPIC Health Plan Senior |
$28.00
|
| Rate for Payer: Galaxy Health WC |
$59.50
|
| Rate for Payer: Global Benefits Group Commercial |
$42.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.00
|
| Rate for Payer: Multiplan Commercial |
$52.50
|
| Rate for Payer: Networks By Design Commercial |
$45.50
|
| Rate for Payer: Prime Health Services Commercial |
$59.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.27
|
| Rate for Payer: United Healthcare All Other HMO |
$25.57
|
| Rate for Payer: United Healthcare HMO Rider |
$25.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.93
|
|
|
HC HEEL PAD FOR SPUR
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
CPT L3480
|
| Hospital Charge Code |
905353480
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.94 |
| Max. Negotiated Rate |
$109.80 |
| Rate for Payer: Adventist Health Commercial |
$50.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$103.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$67.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$91.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$71.65
|
| Rate for Payer: Blue Shield of California Commercial |
$94.31
|
| Rate for Payer: Blue Shield of California EPN |
$61.49
|
| Rate for Payer: Cash Price |
$67.10
|
| Rate for Payer: Cash Price |
$67.10
|
| Rate for Payer: Central Health Plan Commercial |
$97.60
|
| Rate for Payer: Cigna of CA HMO |
$85.40
|
| Rate for Payer: Cigna of CA PPO |
$85.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$103.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$103.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$103.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.80
|
| Rate for Payer: EPIC Health Plan Senior |
$48.80
|
| Rate for Payer: Galaxy Health WC |
$103.70
|
| Rate for Payer: Global Benefits Group Commercial |
$73.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$109.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$26.94
|
| Rate for Payer: InnovAge PACE Commercial |
$61.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$81.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$85.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$85.40
|
| Rate for Payer: Multiplan Commercial |
$91.50
|
| Rate for Payer: Networks By Design Commercial |
$61.00
|
| Rate for Payer: Prime Health Services Commercial |
$103.70
|
| Rate for Payer: Riverside University Health System MISP |
$48.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$73.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$73.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.79
|
| Rate for Payer: United Healthcare All Other HMO |
$44.57
|
| Rate for Payer: United Healthcare HMO Rider |
$43.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$103.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$103.70
|
| Rate for Payer: Vantage Medical Group Senior |
$103.70
|
|
|
HC HEEL PAD FOR SPUR
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
CPT L3480
|
| Hospital Charge Code |
905353480
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$109.80 |
| Rate for Payer: Adventist Health Commercial |
$24.40
|
| Rate for Payer: Blue Shield of California Commercial |
$94.31
|
| Rate for Payer: Blue Shield of California EPN |
$61.49
|
| Rate for Payer: Cash Price |
$67.10
|
| Rate for Payer: Central Health Plan Commercial |
$97.60
|
| Rate for Payer: Cigna of CA HMO |
$85.40
|
| Rate for Payer: Cigna of CA PPO |
$85.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.80
|
| Rate for Payer: EPIC Health Plan Senior |
$48.80
|
| Rate for Payer: Galaxy Health WC |
$103.70
|
| Rate for Payer: Global Benefits Group Commercial |
$73.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$109.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$81.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.40
|
| Rate for Payer: Multiplan Commercial |
$91.50
|
| Rate for Payer: Networks By Design Commercial |
$79.30
|
| Rate for Payer: Prime Health Services Commercial |
$103.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.79
|
| Rate for Payer: United Healthcare All Other HMO |
$44.57
|
| Rate for Payer: United Healthcare HMO Rider |
$43.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.95
|
|
|
HC HEEL PAD FOR SPUR
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
CPT L3480
|
| Hospital Charge Code |
915353480
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.94 |
| Max. Negotiated Rate |
$109.80 |
| Rate for Payer: Adventist Health Commercial |
$50.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$103.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$67.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$91.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$71.65
|
| Rate for Payer: Blue Shield of California Commercial |
$94.31
|
| Rate for Payer: Blue Shield of California EPN |
$61.49
|
| Rate for Payer: Cash Price |
$67.10
|
| Rate for Payer: Cash Price |
$67.10
|
| Rate for Payer: Central Health Plan Commercial |
$97.60
|
| Rate for Payer: Cigna of CA HMO |
$85.40
|
| Rate for Payer: Cigna of CA PPO |
$85.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$103.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$103.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$103.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.80
|
| Rate for Payer: EPIC Health Plan Senior |
$48.80
|
| Rate for Payer: Galaxy Health WC |
$103.70
|
| Rate for Payer: Global Benefits Group Commercial |
$73.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$109.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$26.94
|
| Rate for Payer: InnovAge PACE Commercial |
$61.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$81.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$85.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$85.40
|
| Rate for Payer: Multiplan Commercial |
$91.50
|
| Rate for Payer: Networks By Design Commercial |
$61.00
|
| Rate for Payer: Prime Health Services Commercial |
$103.70
|
| Rate for Payer: Riverside University Health System MISP |
$48.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$73.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$73.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.79
|
| Rate for Payer: United Healthcare All Other HMO |
$44.57
|
| Rate for Payer: United Healthcare HMO Rider |
$43.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$103.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$103.70
|
| Rate for Payer: Vantage Medical Group Senior |
$103.70
|
|
|
HC HEEL PAD FOR SPUR
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
CPT L3480
|
| Hospital Charge Code |
915353480
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$109.80 |
| Rate for Payer: Adventist Health Commercial |
$24.40
|
| Rate for Payer: Blue Shield of California Commercial |
$94.31
|
| Rate for Payer: Blue Shield of California EPN |
$61.49
|
| Rate for Payer: Cash Price |
$67.10
|
| Rate for Payer: Central Health Plan Commercial |
$97.60
|
| Rate for Payer: Cigna of CA HMO |
$85.40
|
| Rate for Payer: Cigna of CA PPO |
$85.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.80
|
| Rate for Payer: EPIC Health Plan Senior |
$48.80
|
| Rate for Payer: Galaxy Health WC |
$103.70
|
| Rate for Payer: Global Benefits Group Commercial |
$73.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$109.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$81.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.40
|
| Rate for Payer: Multiplan Commercial |
$91.50
|
| Rate for Payer: Networks By Design Commercial |
$79.30
|
| Rate for Payer: Prime Health Services Commercial |
$103.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.79
|
| Rate for Payer: United Healthcare All Other HMO |
$44.57
|
| Rate for Payer: United Healthcare HMO Rider |
$43.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.95
|
|
|
HC HEEL PAD REMOVABLE FOR SPUR
|
Facility
|
OP
|
$106.00
|
|
|
Service Code
|
CPT L3485
|
| Hospital Charge Code |
905353485
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$34.72 |
| Max. Negotiated Rate |
$95.40 |
| Rate for Payer: Adventist Health Commercial |
$43.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$90.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$58.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$79.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.25
|
| Rate for Payer: Blue Shield of California Commercial |
$81.94
|
| Rate for Payer: Blue Shield of California EPN |
$53.42
|
| Rate for Payer: Cash Price |
$58.30
|
| Rate for Payer: Cash Price |
$58.30
|
| Rate for Payer: Central Health Plan Commercial |
$84.80
|
| Rate for Payer: Cigna of CA HMO |
$74.20
|
| Rate for Payer: Cigna of CA PPO |
$74.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$90.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$90.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$90.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.40
|
| Rate for Payer: EPIC Health Plan Senior |
$42.40
|
| Rate for Payer: Galaxy Health WC |
$90.10
|
| Rate for Payer: Global Benefits Group Commercial |
$63.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$95.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$52.01
|
| Rate for Payer: InnovAge PACE Commercial |
$53.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$65.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$74.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$74.20
|
| Rate for Payer: Multiplan Commercial |
$79.50
|
| Rate for Payer: Networks By Design Commercial |
$53.00
|
| Rate for Payer: Prime Health Services Commercial |
$90.10
|
| Rate for Payer: Riverside University Health System MISP |
$42.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$63.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$63.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$39.78
|
| Rate for Payer: United Healthcare All Other HMO |
$38.72
|
| Rate for Payer: United Healthcare HMO Rider |
$37.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$90.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$90.10
|
| Rate for Payer: Vantage Medical Group Senior |
$90.10
|
|
|
HC HEEL PAD REMOVABLE FOR SPUR
|
Facility
|
IP
|
$106.00
|
|
|
Service Code
|
CPT L3485
|
| Hospital Charge Code |
905353485
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$21.20 |
| Max. Negotiated Rate |
$95.40 |
| Rate for Payer: Adventist Health Commercial |
$21.20
|
| Rate for Payer: Blue Shield of California Commercial |
$81.94
|
| Rate for Payer: Blue Shield of California EPN |
$53.42
|
| Rate for Payer: Cash Price |
$58.30
|
| Rate for Payer: Central Health Plan Commercial |
$84.80
|
| Rate for Payer: Cigna of CA HMO |
$74.20
|
| Rate for Payer: Cigna of CA PPO |
$74.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.40
|
| Rate for Payer: EPIC Health Plan Senior |
$42.40
|
| Rate for Payer: Galaxy Health WC |
$90.10
|
| Rate for Payer: Global Benefits Group Commercial |
$63.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$95.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$65.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.20
|
| Rate for Payer: Multiplan Commercial |
$79.50
|
| Rate for Payer: Networks By Design Commercial |
$68.90
|
| Rate for Payer: Prime Health Services Commercial |
$90.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$39.78
|
| Rate for Payer: United Healthcare All Other HMO |
$38.72
|
| Rate for Payer: United Healthcare HMO Rider |
$37.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.72
|
|
|
HC HEEL PRTCTR STABLIZ WEDGE STRD
|
Facility
|
IP
|
$266.00
|
|
| Hospital Charge Code |
901698881
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$53.20 |
| Max. Negotiated Rate |
$239.40 |
| Rate for Payer: Adventist Health Commercial |
$53.20
|
| Rate for Payer: Cash Price |
$146.30
|
| Rate for Payer: Central Health Plan Commercial |
$212.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.40
|
| Rate for Payer: EPIC Health Plan Senior |
$106.40
|
| Rate for Payer: Galaxy Health WC |
$226.10
|
| Rate for Payer: Global Benefits Group Commercial |
$159.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$239.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$177.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$164.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.20
|
| Rate for Payer: Multiplan Commercial |
$199.50
|
| Rate for Payer: Networks By Design Commercial |
$172.90
|
| Rate for Payer: Prime Health Services Commercial |
$226.10
|
|
|
HC HEEL PRTCTR STABLIZ WEDGE STRD
|
Facility
|
OP
|
$266.00
|
|
| Hospital Charge Code |
901698881
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$53.20 |
| Max. Negotiated Rate |
$239.40 |
| Rate for Payer: Adventist Health Commercial |
$53.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$161.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$226.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$146.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$199.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$128.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$156.22
|
| Rate for Payer: Blue Shield of California Commercial |
$162.53
|
| Rate for Payer: Blue Shield of California EPN |
$106.13
|
| Rate for Payer: Cash Price |
$146.30
|
| Rate for Payer: Central Health Plan Commercial |
$212.80
|
| Rate for Payer: Cigna of CA HMO |
$170.24
|
| Rate for Payer: Cigna of CA PPO |
$196.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$226.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$226.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$226.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.40
|
| Rate for Payer: EPIC Health Plan Senior |
$106.40
|
| Rate for Payer: Galaxy Health WC |
$226.10
|
| Rate for Payer: Global Benefits Group Commercial |
$159.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$239.40
|
| Rate for Payer: InnovAge PACE Commercial |
$133.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$177.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$164.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$186.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$186.20
|
| Rate for Payer: Multiplan Commercial |
$199.50
|
| Rate for Payer: Networks By Design Commercial |
$172.90
|
| Rate for Payer: Prime Health Services Commercial |
$226.10
|
| Rate for Payer: Riverside University Health System MISP |
$106.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$159.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$159.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$133.00
|
| Rate for Payer: United Healthcare All Other HMO |
$133.00
|
| Rate for Payer: United Healthcare HMO Rider |
$133.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$133.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$226.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$226.10
|
| Rate for Payer: Vantage Medical Group Senior |
$226.10
|
|
|
HC HEEL PRTCTR W/STABLIZ WEDGE XL
|
Facility
|
IP
|
$353.80
|
|
| Hospital Charge Code |
901698880
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$70.76 |
| Max. Negotiated Rate |
$318.42 |
| Rate for Payer: Adventist Health Commercial |
$70.76
|
| Rate for Payer: Cash Price |
$194.59
|
| Rate for Payer: Central Health Plan Commercial |
$283.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$141.52
|
| Rate for Payer: EPIC Health Plan Senior |
$141.52
|
| Rate for Payer: Galaxy Health WC |
$300.73
|
| Rate for Payer: Global Benefits Group Commercial |
$212.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$318.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$235.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$134.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$219.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.76
|
| Rate for Payer: Multiplan Commercial |
$265.35
|
| Rate for Payer: Networks By Design Commercial |
$229.97
|
| Rate for Payer: Prime Health Services Commercial |
$300.73
|
|
|
HC HEEL PRTCTR W/STABLIZ WEDGE XL
|
Facility
|
OP
|
$353.80
|
|
| Hospital Charge Code |
901698880
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$70.76 |
| Max. Negotiated Rate |
$318.42 |
| Rate for Payer: Adventist Health Commercial |
$70.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$214.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$300.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$194.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$265.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$171.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$207.79
|
| Rate for Payer: Blue Shield of California Commercial |
$216.17
|
| Rate for Payer: Blue Shield of California EPN |
$141.17
|
| Rate for Payer: Cash Price |
$194.59
|
| Rate for Payer: Central Health Plan Commercial |
$283.04
|
| Rate for Payer: Cigna of CA HMO |
$226.43
|
| Rate for Payer: Cigna of CA PPO |
$261.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$300.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$300.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$300.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$141.52
|
| Rate for Payer: EPIC Health Plan Senior |
$141.52
|
| Rate for Payer: Galaxy Health WC |
$300.73
|
| Rate for Payer: Global Benefits Group Commercial |
$212.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$318.42
|
| Rate for Payer: InnovAge PACE Commercial |
$176.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$235.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$134.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$219.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$247.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$247.66
|
| Rate for Payer: Multiplan Commercial |
$265.35
|
| Rate for Payer: Networks By Design Commercial |
$229.97
|
| Rate for Payer: Prime Health Services Commercial |
$300.73
|
| Rate for Payer: Riverside University Health System MISP |
$141.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$212.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$212.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$176.90
|
| Rate for Payer: United Healthcare All Other HMO |
$176.90
|
| Rate for Payer: United Healthcare HMO Rider |
$176.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$176.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$300.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$300.73
|
| Rate for Payer: Vantage Medical Group Senior |
$300.73
|
|
|
HC HEEL SACH CUSHION TYPE
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
CPT L3450
|
| Hospital Charge Code |
915353450
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Blue Shield of California Commercial |
$162.33
|
| Rate for Payer: Blue Shield of California EPN |
$105.84
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Central Health Plan Commercial |
$168.00
|
| Rate for Payer: Cigna of CA HMO |
$147.00
|
| Rate for Payer: Cigna of CA PPO |
$147.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Senior |
$84.00
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$189.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$129.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: Networks By Design Commercial |
$136.50
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$78.81
|
| Rate for Payer: United Healthcare All Other HMO |
$76.71
|
| Rate for Payer: United Healthcare HMO Rider |
$75.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$68.78
|
|
|
HC HEEL SACH CUSHION TYPE
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
CPT L3450
|
| Hospital Charge Code |
915353450
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$68.78 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Adventist Health Commercial |
$86.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$115.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$157.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$123.33
|
| Rate for Payer: Blue Shield of California Commercial |
$162.33
|
| Rate for Payer: Blue Shield of California EPN |
$105.84
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Central Health Plan Commercial |
$168.00
|
| Rate for Payer: Cigna of CA HMO |
$147.00
|
| Rate for Payer: Cigna of CA PPO |
$147.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$178.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$178.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$178.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Senior |
$84.00
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$189.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$108.03
|
| Rate for Payer: InnovAge PACE Commercial |
$105.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$119.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$129.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$147.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$147.00
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: Networks By Design Commercial |
$105.00
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
| Rate for Payer: Riverside University Health System MISP |
$84.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$126.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$126.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$78.81
|
| Rate for Payer: United Healthcare All Other HMO |
$76.71
|
| Rate for Payer: United Healthcare HMO Rider |
$75.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$68.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$178.50
|
| Rate for Payer: Vantage Medical Group Senior |
$178.50
|
|
|
HC HEEL SACH CUSHION TYPE
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
CPT L3450
|
| Hospital Charge Code |
905353450
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Blue Shield of California Commercial |
$162.33
|
| Rate for Payer: Blue Shield of California EPN |
$105.84
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Central Health Plan Commercial |
$168.00
|
| Rate for Payer: Cigna of CA HMO |
$147.00
|
| Rate for Payer: Cigna of CA PPO |
$147.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Senior |
$84.00
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$189.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$129.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: Networks By Design Commercial |
$136.50
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$78.81
|
| Rate for Payer: United Healthcare All Other HMO |
$76.71
|
| Rate for Payer: United Healthcare HMO Rider |
$75.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$68.78
|
|
|
HC HEEL SACH CUSHION TYPE
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
CPT L3450
|
| Hospital Charge Code |
905353450
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$68.78 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Adventist Health Commercial |
$86.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$115.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$157.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$123.33
|
| Rate for Payer: Blue Shield of California Commercial |
$162.33
|
| Rate for Payer: Blue Shield of California EPN |
$105.84
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Central Health Plan Commercial |
$168.00
|
| Rate for Payer: Cigna of CA HMO |
$147.00
|
| Rate for Payer: Cigna of CA PPO |
$147.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$178.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$178.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$178.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Senior |
$84.00
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$189.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$108.03
|
| Rate for Payer: InnovAge PACE Commercial |
$105.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$119.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$129.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$147.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$147.00
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: Networks By Design Commercial |
$105.00
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
| Rate for Payer: Riverside University Health System MISP |
$84.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$126.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$126.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$78.81
|
| Rate for Payer: United Healthcare All Other HMO |
$76.71
|
| Rate for Payer: United Healthcare HMO Rider |
$75.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$68.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$178.50
|
| Rate for Payer: Vantage Medical Group Senior |
$178.50
|
|
|
HC HEEL THOMAS EXTENDED TO BALL
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
CPT L3470
|
| Hospital Charge Code |
905353470
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$109.80 |
| Rate for Payer: Adventist Health Commercial |
$24.40
|
| Rate for Payer: Blue Shield of California Commercial |
$94.31
|
| Rate for Payer: Blue Shield of California EPN |
$61.49
|
| Rate for Payer: Cash Price |
$67.10
|
| Rate for Payer: Central Health Plan Commercial |
$97.60
|
| Rate for Payer: Cigna of CA HMO |
$85.40
|
| Rate for Payer: Cigna of CA PPO |
$85.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.80
|
| Rate for Payer: EPIC Health Plan Senior |
$48.80
|
| Rate for Payer: Galaxy Health WC |
$103.70
|
| Rate for Payer: Global Benefits Group Commercial |
$73.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$109.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$81.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.40
|
| Rate for Payer: Multiplan Commercial |
$91.50
|
| Rate for Payer: Networks By Design Commercial |
$79.30
|
| Rate for Payer: Prime Health Services Commercial |
$103.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.79
|
| Rate for Payer: United Healthcare All Other HMO |
$44.57
|
| Rate for Payer: United Healthcare HMO Rider |
$43.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.95
|
|
|
HC HEEL THOMAS EXTENDED TO BALL
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
CPT L3470
|
| Hospital Charge Code |
905353470
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$30.62 |
| Max. Negotiated Rate |
$109.80 |
| Rate for Payer: Adventist Health Commercial |
$50.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$103.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$67.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$91.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$71.65
|
| Rate for Payer: Blue Shield of California Commercial |
$94.31
|
| Rate for Payer: Blue Shield of California EPN |
$61.49
|
| Rate for Payer: Cash Price |
$67.10
|
| Rate for Payer: Cash Price |
$67.10
|
| Rate for Payer: Central Health Plan Commercial |
$97.60
|
| Rate for Payer: Cigna of CA HMO |
$85.40
|
| Rate for Payer: Cigna of CA PPO |
$85.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$103.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$103.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$103.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.80
|
| Rate for Payer: EPIC Health Plan Senior |
$48.80
|
| Rate for Payer: Galaxy Health WC |
$103.70
|
| Rate for Payer: Global Benefits Group Commercial |
$73.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$109.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$30.62
|
| Rate for Payer: InnovAge PACE Commercial |
$61.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$81.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$85.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$85.40
|
| Rate for Payer: Multiplan Commercial |
$91.50
|
| Rate for Payer: Networks By Design Commercial |
$61.00
|
| Rate for Payer: Prime Health Services Commercial |
$103.70
|
| Rate for Payer: Riverside University Health System MISP |
$48.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$73.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$73.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.79
|
| Rate for Payer: United Healthcare All Other HMO |
$44.57
|
| Rate for Payer: United Healthcare HMO Rider |
$43.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$103.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$103.70
|
| Rate for Payer: Vantage Medical Group Senior |
$103.70
|
|
|
HC HEEL THOMAS EXTENDED TO BALL
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
CPT L3470
|
| Hospital Charge Code |
915353470
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$109.80 |
| Rate for Payer: Adventist Health Commercial |
$24.40
|
| Rate for Payer: Blue Shield of California Commercial |
$94.31
|
| Rate for Payer: Blue Shield of California EPN |
$61.49
|
| Rate for Payer: Cash Price |
$67.10
|
| Rate for Payer: Central Health Plan Commercial |
$97.60
|
| Rate for Payer: Cigna of CA HMO |
$85.40
|
| Rate for Payer: Cigna of CA PPO |
$85.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.80
|
| Rate for Payer: EPIC Health Plan Senior |
$48.80
|
| Rate for Payer: Galaxy Health WC |
$103.70
|
| Rate for Payer: Global Benefits Group Commercial |
$73.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$109.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$81.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.40
|
| Rate for Payer: Multiplan Commercial |
$91.50
|
| Rate for Payer: Networks By Design Commercial |
$79.30
|
| Rate for Payer: Prime Health Services Commercial |
$103.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.79
|
| Rate for Payer: United Healthcare All Other HMO |
$44.57
|
| Rate for Payer: United Healthcare HMO Rider |
$43.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.95
|
|
